HCR -- Yet Another Screed

By John Ballard

Very few readers of Newshoggers need any further evidence that America's health care system ("best in the world" you know) is both full of holes and insanely expensive. So today's link to Cassandra Does Tokyo is provided more for amusement than information.
I use the word amusement sarcastically in the same way that one might joke about a squeaking prosthetic needing WD-40 in the aftermath of an accident resulting in the loss of a leg or two.
Such is the shape of US healthcare when measured against the rest of what are carelessly called "developed countries."

This is a three-part story opening with an anecdotal account of the author's food poisoning about thirty years ago and his subsequent experience with the American health care system which was as vile as the sickness itself. (I presume he is either European studying or working in the US or an American who will become an expat later,)

Next is a first-person glimpse of the British system as one of his children needs medical attention for a heart condition. By now he has a better lifestyle. Living in Britain they go first to the NHS, but turned to the private sector upon learning that NHS rationing would result in a six-week delay.

The attending GP suggested that she see a specialist. By nature of her residence, she's covered by the NHS. Rationing queue meant the earliest appointment was six weeks. However, if she wanted to jump the queue, the specialist will see her privately immediately. Cost? GBP800. That is just for the consultation - presumably (though not assuredly) including the ECG & stress test(s). Rather than be pick-pocketed by over-enterprising UK cardiologist, we are able to get an appointment at a private practice near our home in France (BTW, contrary to popular belief in the US and the UK, all practices in France are private) in two weeks coinciding with her next visit home. She undergoes a thorough exam, stress tests and ECG. Useful but inconclusive. Cost? GBP100. (Note: That is not the co-payment. That is the invoiced amount!!). In the absence of seeing her when another episode might arises, he recommends an MRI (with hi-tech contrast media etc.) to rule out the worst. We make an appointment (also at a private clinic) for two-days hence. Tests are completed. New machines. Super high-tech gear. Cost? GBP125, inclusive of radiographer's reading and opinion. This is, again, NOT the co-pay (in US lingo), but the private price to the customer. This is the usual and customary cost reimbursed by the State Single Payer. They extend the same price to me without question, so I don't have to be Kaiser Permanente to obtain their volume discount. Each visit type or procedure has a price. That is that. Full transparency. Not one price for the insurance company and the other "retail walk-in's". One price. One of my children had a small tongue-tie clipped at a suburban New York hospital. The anaesthesiologist alone charged $800 (and that was 10 years ago) for the 10-minutes and two-jokes (not including the cost of the anaesthetic itself), while the full procedure was $6000 (retail, walk-in, rack-rate price). In France they do this as an outpatient procedure in the ENT surgeon's office with a local anaesthetic, for less than a twentieth of the price. I can only imagine what my daughter's same two cardiological and radiological consultations and procedures would have cost in the US (but would be fascinated whether anyone knows the range of prices one might encounter).

The third part of this post is a commentary on the price variations among the three countries -- US, Britain and France -- and observations of how private health care contrasts with nationalized health care.

The troubling thing to an Economist (or me at least, lest I shame Economists if such a thing were possible), is the sheer discrepancy between these actual prices. These are factors of 6x between the private UK price and private French price (even before the USA weighs in). We are not talking about a hospital in India where the reward for saving 75% on your procedure is an untreatable staphylococcus infection that might very-well kill you. Remember, the French cardiologists and radiologists are private. They are running businesses. They are free to charge what they want. Their equipment is not subsidized, so presumably the fees per scan and payback periods of their MRI scanner must make some economic sense. This is not Greece or Portugal sovereign, and French banks are notoriously hard-nosed with domestic small business customers who get their sums wrong (unlike the lax scrutiny they gave to Europe's peripheral sovereigns. Admittedly, prices in the 16th of Paris would be somewhat higher, but nonetheless my region is one of the wealthiest in France. So one might ask, Why is this so?

Well for a start, French doctors and specialists are probably underpaid. But they are not starving, though they are clearly bearing some of the difference, particularly GPs and Dentists. Why don't they just charge more? Well, for one, most people wouldn't pay or couldn't pay, and would seek out the provider charging the usual and customary reimbursed by the Single Payor. France also has a single nationwide healthcare IT system interfacing with all providers which is a huge advantage, both from a cost and ability to track fraud point of view.

I'm providing this link mostly for the sheer pleasure of reading the prose. Like heavily-seasoned food it has just enough spice to make it a good read.
And instead of a postprandial imported cigar, take a look at the comments thread, a litany of Amens, several of which come with their own anecdotal examples.

• From Taiwan "One of the things I dread most about my return to the United States is the return to the broken health care system."


• We had a similar experience where my wife was stung by a bee and we went to the emergency room in France. No wait. Pleasant. Wound dressed, doctor met and prescription provided. Exemplary service let alone care. And then the bill. One price. $54. For the love of pete they have the better way. We are so broken and stupid not to demand similarly.


• Considering stress is not exactly healthy either, maybe some of the better outcomes of the French system are simply due to the absence of medical-finance related worries in patients?


• I wonder if the French have lower costs due to less end-of-life care? As a society, I'm not sure Americans would accept this trade off.


• (And from the author:) Again, these are anecdotes. The facts remain: US spends 19% of GDP for byzantine chaotic partial coverage system with flaws large enough for the moon to pass through, where as an essentially private system of providers bounded by a single-payer as equal guardian of patient rights and tax-payer interests expends 12% for universal coverage and - in comparison to the US - relatively minor systemic flaws.

Much more at the link. Read. Enjoy. And weep.